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Clinical QA Specialist
ProCare Rx
- Gainesville, Florida, United States
- Gainesville, Florida, United States
Über
ESSENTIAL DUTIES AND RESPONSIBILITIES
Execute QA-related tasks and processes in the Business QA department.
Provide specific attention to clinical changes for government programs.
Review and validate that rules and utilization management along with clinical edits are programmed against clinical policies accurately.
Write reports that will produce accurate information needed to validate that clinical changes are accurate.
Review all material at hand to determine if benefit changes match requests from the client.
Provide feedback to multiple departments on benefit configuration supporting clinical requests.
Work with various departments as needed to have plans updated to satisfy requested changes.
Perform pre and post implementation testing on benefit set up to ensure claims process accurately.
Document and track testing procedures for new functionality.
Make presentations to your peers as a department learning tool.
Miscellaneous duties as requested.
QUALIFICATIONS AND REQUIREMENTS
Certified Pharmacy Technician with at least 3 years experience required.
Strong knowledge of pharmacy terminology and medication management to interpret clinical guidelines.
Quality Control in a HealthPlan setting is preferred.
Experience in testing system applications and reading results highly desired.
Ability to perform data audits using tools like Excel or SQL.
Clear, concise written and verbal communication skills a plus.
Ability to multitask and adapt to changes as items are reprioritized.
Familiarity with regulatory or state specific clinical regulations governing pharmacy benefits.
Knowledge of R&R Reports works a plus.
PHYSICAL DEMANDS Requires sitting, standing, and occasional light lifting.
EEO STATEMENT ProCareRx is an Equal Opportunity Employer. This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
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Sprachkenntnisse
- English
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